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Billing news

Modified: 9/9/2022
This article informs you and your vendors about changes that will allow you to request reopening of claims electronically.
Modified: 4/5/2024
This article will assist Medicare Part A providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 4/4/2024
First Coast requests specific documentation with submission of CPT Category III T Codes.
Modified: 4/1/2024
Instructions for billing digitization of glass microscope slides, CPT codes 0751T-0763T.
Modified: 3/30/2024
Modified: 3/16/2024
This article is a reminder for all outpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 3/15/2024
See this article for information pertaining to Change Healthcare/Optum payment disruption (CHOPD) accelerated payments to Part A providers and advance payments to Part B suppliers.
Modified: 3/15/2024
Based on claims reviewed by the recovery audit contractor (RAC), First Coast has identified top denials for services within the category of vein ablation (codes 36475 and 36478) relating to endovenous radiofrequency ablation and laser treatment for lower extremity varicose veins. Common findings indicate that medical necessity and documentation requirements are often not supported within the medical records submitted.
Modified: 3/5/2024
Review this article for guidance on billing the home administration code M0201 when administering the COVID-19 vaccine.
Modified: 3/2/2024
Read this article to learn more about radioactive diagnostic agents for positron emission tomography of prostate-specific membrane antigen positive lesions in men with prostate cancer.
Modified: 2/29/2024
First Coast would like to ensure providers performing biopsy services understand how to properly bill and code for these procedures. Recent data indicates improper billing so we want to provide clarification of top issues we identified.
Modified: 2/25/2024
Important information you should know before billing J9035 for Avastin (bevacizumab).
Modified: 2/23/2024
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with reason code 34963. Read on for more information.
Modified: 2/22/2024
The requirements for the submission of claims under reciprocal billing and fee-for-time compensation arrangements are the same for assigned and non-assigned claims. This article shows when these requirements apply.
Modified: 2/21/2024
This information outlines the process for the 935 recoupment.
Modified: 2/17/2024
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
Modified: 2/16/2024
To determine if a claim was medically reviewed, providers should submit the requests correctly. [Provider Outreach and Education]
Modified: 2/16/2024
To determine if a claim was medically reviewed, providers should Submit the requests correctly. [Provider Outreach and Education]
Modified: 2/16/2024
Read this article to learn how to resolve claim rejects for reason code 34963. [First Coast Provider Outreach and Education]
Modified: 2/16/2024
First Coast rejects claims returned to a provider more than three times with reason code 70RTP. Read this article to learn more about this reason code.
Modified: 2/12/2024
As a result of the termination of the public health emergency (PHE) on May 11, 2023, CMS will no longer pay for certain HCPCS codes for COVID-19 laboratory tests.
Modified: 2/12/2024
Modified: 2/9/2024
View this new page to easily locate information related to drugs and biologicals, such as billing and coding guidelines, related policy information, IOMs, and resources.
Modified: 2/9/2024
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read this article for more information.
Modified: 2/2/2024
Are you sending hardcopy mail to submit your requests to First Coast? Avoid the wait. There are faster and easier ways to send your requests to us. Learn about the electronic options available for you.
Modified: 1/31/2024
First Coast reminds providers that CMS updated MLN12124, which was initially released in March 2021, addressing NCD 90.2, Next Generation Sequencing (NGS), and the expiration of certain ICD-10 codes.
Modified: 1/26/2024
This article will assist providers with proper billing relating to the Mpox vaccine and laboratory codes. Note: This article was updated September 6 to advise providers to include the product code on claims.
Modified: 1/26/2024
How to bill for skin substitute coes A2001-A2010
Physicians and non-physician practitioners who perform procedure codes CPT 15271-15278 (application of skin substitute) may bill separately for skin substitute codes A2001-A2010.
Modified: 1/25/2024
Are you providing outpatient therapy services on institutional claims and receiving reason code 34963 indicating the attending physician is invalid? Read this article for assistance to resolve your claim returns.
Modified: 1/25/2024
The MPPR on diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the same session on the same day. Find out the details here.
Modified: 1/24/2024
Data indicates that many providers are not submitting proper diagnosis codes to support the medical necessity for tetanus vaccinations.
Modified: 1/24/2024
Medical documentation from ordering physicians plays a vital role in validating medical necessity of ordered laboratory tests.
Modified: 1/18/2024
View information related to the 340B Drug Payment Policy Remedy
Modified: 1/18/2024
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with substance use disorders. This article addresses institutional billing requirements for these new services.
Modified: 1/17/2024
This article will assist Medicare Part B providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 1/17/2024
Providers may be billing these services incorrectly. Please review this article and pay close attention to the billing loop and segment information detailed within. The NCT number has been added to the instructions.
Modified: 1/17/2024
Effective June 21, both the standard and expedited PAR coversheets are updated with new fields to improve the prior authorization request (PAR) process. The new fields include the facility fax number, the physician fax number, and a field relating to the implanted spinal neurostimulator.
Modified: 1/3/2024
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
Modified: 10/25/2023
CMS has issued the 2023 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. 2023 KX modifier thresholds are also available. [MM12903]
Modified: 10/23/2023
Learn about First Coast's electronic submission options.
Modified: 10/23/2023
Learn about First Coast's electronic submission options.
Modified: 10/19/2023
CMS has issued the 2024 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [CR13365]
Modified: 10/11/2023
Read the following article for the most common billing requirements for end-stage renal disease related services.
Modified: 10/11/2023
Are you submitting claims with procedure codes that aren't valid for Medicare? First Coast returns these claims to providers. Read this article to learn more about unprocessable claims.
Modified: 10/6/2023
This article assists with billing requirements for cochlear implant batteries L8621-L8624.
Modified: 8/17/2023
If your claim was returned for incorrect units of dialysis service billed for the Tablo hemodialysis machine use, please read this article to learn how the claim should be correctly billed.
Modified: 7/14/2023
Medicare applies a MPPR to the payment of select therapy services. The reduction applies to HCPCS codes contained on the list of “always therapy” services, regardless of the type of provider or supplier furnishing the services. Find out the details here.
Modified: 4/27/2023
Reminder regarding correct reporting of micro or minimally invasive glaucoma surgery (MIGS)
Modified: 2/15/2023
Important information you must know when billing for Prolia® (denosumab) injections, J0897.
Modified: 1/3/2023
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 4.625 % is in effect January through July 2023. [Publication 100-04, Chapter 1, Section 80.2.2]
Modified: 1/3/2023
Avoid ambulatory surgery center (ASC) claim denials for incorrect coding and documentation issues with CPT code 63685. Read more about proper billing for this service.
Modified: 11/29/2022
Avoid ambulatory surgical center (ASC) claim denials for incorrect coding and documentation issues with CPT code 52332. Read more about proper billing for this service.
Modified: 6/23/2022
Most services billed to Medicare must reflect the exact date the service was performed for or provided to the patient. This article discusses situations where there have been questions from the provider community. [SE17023]
Modified: 6/15/2022
Services designated as “inpatient only” are not appropriate to be furnished in a hospital outpatient department.
Modified: 1/6/2022
This article is a reminder for all inpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 12/1/2021
CMS has issued the 2022 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12507]
Modified: 10/15/2021
Providers billing Medicare should determine if a patient is enrolled in hospice before billing Medicare Part A. This article has tips on checking patient eligibility and avoiding hospice claim rejects.
Modified: 9/24/2021
Avoid claim rejects. If you bill E/M codes within the CPT code range 99201-99239, do not report more than one unit per date of service.
Modified: 9/15/2021
CMS has identified a claims processing issue that potentially impacts all Cohort 1 Primary Care First (PCF) participants that submitted claims for flat visit fee (FVF) eligible services processed between January 1, 2021, and February 3, 2021.
Modified: 7/20/2021
Documentation is required to process claims for ventricular assist device (VAD) supplies. View this article regarding how to avoid delays when billing VAD supplies.
Modified: 3/10/2021
CMS has issued the 2021 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12024]
Modified: 3/4/2021
Modified: 12/15/2020
Transmittal 10486, dated November 19, 2020, is being rescinded and replaced by transmittal 10520, dated December 14, 2020, to revise the implementation date from December 14, 2020, to December 21, 2020. All other information remains the same. [CR11642]
Modified: 11/14/2020
Medicare claims processing systems will accept HCPCS code U0001 on April 1, 2020, for dates of service on or after February 4, 2020.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.